ADM Equipment Operation & Maintenance 3 — Questions and Answers
Question 1: In an opioid treatment program (OTP), a methadone dispensing machine experiences a power failure mid-dose. What is the correct immediate action?
- Manually estimate the remaining dose by visual inspection and administer it
- Discard the partial dose, document the incident, and dispense a full dose from a backup supply per protocol
- Hold all patient dosing until full power is restored to the machine (Correct answer)
- Switch the patient to buprenorphine as an emergency substitution
Correct answer: Hold all patient dosing until full power is restored to the machine
When a dispensing machine fails mid-operation, patient dosing should be held and the incident documented; resuming with an unvalidated partial dose risks inaccurate delivery.
Question 2: Buprenorphine sublingual film (Suboxone) strips must be stored at room temperature (68–77°F / 20–25°C). What storage condition poses the greatest risk of product degradation?
- Storing in a locked double-security cabinet away from light
- Storing near a sink where humidity and temperature fluctuations are common (Correct answer)
- Keeping the strips in their original foil packaging until dispensed
- Maintaining storage logs at daily intervals
Correct answer: Storing near a sink where humidity and temperature fluctuations are common
High humidity and temperature fluctuation, such as near a sink, can degrade buprenorphine film and compromise dose integrity.
Question 3: When calibrating a methadone oral dispensing pump in an OTP, a technician finds the pump delivers 1.2 mL instead of the set 1.0 mL. What is the appropriate response?
- Accept the reading, as a 20% variation is within normal tolerance
- Take the pump out of service, document the finding, and arrange for recalibration or replacement (Correct answer)
- Manually adjust future doses downward by 20% without recalibrating the device
- Continue using the pump only for patients prescribed doses above 50 mg
Correct answer: Take the pump out of service, document the finding, and arrange for recalibration or replacement
A 20% volumetric error is clinically significant for a narrow-therapeutic-index drug like methadone; the pump must be removed from service until properly recalibrated.
Question 4: DEA regulations require that Schedule II controlled substances (including methadone) dispensed at an OTP be stored in which type of secured container?
- A locked filing cabinet rated for burglary resistance (B-rating)
- A DEA-compliant safe or steel cabinet that is bolted to the floor or wall (Correct answer)
- Any lockable refrigerator with a patient data log
- A locked room with a biometric access system only
Correct answer: A DEA-compliant safe or steel cabinet that is bolted to the floor or wall
DEA regulations (21 CFR 1301.75) require Schedule II substances to be stored in a securely locked, substantially constructed cabinet bolted to prevent removal.
Question 5: A pharmacy dispensing naltrexone extended-release injectable (Vivitrol) receives a shipment that has been maintained at 45°F (7°C) during transit. What should the pharmacist do?
- Administer the product immediately before further temperature damage occurs
- Return or quarantine the shipment, as Vivitrol must be refrigerated between 36–46°F and transit conditions must be documented (Correct answer)
- Store at room temperature for 7 days to restore potency before dispensing
- Dispense normally, as slight cold-chain deviations do not affect injectables
Correct answer: Return or quarantine the shipment, as Vivitrol must be refrigerated between 36–46°F and transit conditions must be documented
Vivitrol must be stored refrigerated (36–46°F); any temperature excursion requires documentation and manufacturer consultation before dispensing.
Question 6: When a clinic dispenses take-home methadone doses in individual bottles, which labeling element is required by federal OTP regulations?
- The patient's insurance ID number
- The patient's name, the dispensing date, and the dose amount (Correct answer)
- The names of all clinic staff who prepared the dose
- The expiration date of the original bulk methadone liquid
Correct answer: The patient's name, the dispensing date, and the dose amount
Federal OTP regulations (42 CFR Part 8) require take-home bottles to be labeled with the patient's name, dispensing date, and dose to prevent misuse or diversion.
Question 7: Which of the following maintenance tasks is most critical for ensuring accurate operation of an automated pill counter used in a medication-assisted treatment (MAT) clinic?
- Replacing the battery every 6 months regardless of indicator status
- Cleaning the counting tray and photoelectric sensor after each use to remove powder residue (Correct answer)
- Recalibrating the device annually using sugar pills as a substitute
- Lubricating the mechanical gears with petroleum jelly monthly
Correct answer: Cleaning the counting tray and photoelectric sensor after each use to remove powder residue
Residue from tablets can coat the photoelectric sensor, causing miscounts; cleaning after each use is essential for accurate medication dispensing.
ADM Equipment Operation & Maintenance 3
In an opioid treatment program (OTP), a methadone dispensing machine experiences a power failure mid-dose.
What is the correct immediate action?